But I still think, of course, there should be a greater liaison and communication between the number of migrant clinics throughout the country that exist expecially in one given migrant stream.

Senator WILLIAMS. A lot of the diseases that you deal with are highly contagious; are they not?

Dr. LOCEY. Well, you will find in the statistics that the major diseases we come across are respiratory diseases.

From the standpoint of dangerous communicable diseases, there may not be many, but when they occur, they are important.

We did have one case of poliomyelitis that was discovered in our clinic in 1966.

Senator WILLIAMS. You are in agreement with all our other witnesses that addressed themselves to this appropriation, that the migrant health program should stand on its own feet, and not be put in the common pot, as you said, with the comprehensive program, because it might well get lost there?

Dr. LOCEY. Yes, sir.

Senator WILLIAMS. And we had directors of the health departments of four or five States, and they, without our asking them to comment, all volunteered the same observation that you did.

We did not ask you, did we?
Dr. LOCEY. No.

Senator Williams. So it came purely as an observation that you make from the fields where you work. Is that right?

Dr. LOCEY. This is correct.

Senator Williams. Well, we certainly kept you late, and, as I said the other day, while we feed the spirit and feed the mind, the time comes when we ought to be feeding the body. So at 1:22 we adjourn this hearing, and I cannot guarantee this, but we feel confident that your apprehension that this program might die on June 30 next year can be allayed, or dismissed, because on this committee I think we are in general agreement that the program must continue.

We are going to have some editorial problems in completing the record, with some charts and graphs and statistics, so without objection, the staff will be authorized to edit it for publishing purposes. (The following material was subsequently received.)

ARIZONA STATE DEPARTMENT OF HEALTH,

Phoenix, Ariz., December 19, 1967. Re S. 2688. Hon. HLARRISON WILLIAMS, Chairman, Migrant Health Subcommittee, New Senale Office Building, Washington, D.C.

DEAR SIR: The fertile valleys of central and southwestern Arizona constitute one of the nation's largest and most important agricultural areas producing close to $300 million worth of cotton, vegetables, grains, citrus, alfalfa and other agricultural products, accounting for more than ten per cent of Arizona's economy.

An estimated 40,000 domestic migrant farm workers are employed year-round throughout the agricultural areas in Arizona, following the harvest seasons from county to county within the State or inter-state from California, Texas, New Mexico to Utah, Nevada, Colorado, Oregon and Washington.

The average family income of these migrants is far below the poverty level, averaging about $1200 annually from our own observations in Migrant Health Clinics.

To protect the health of this high risk minority group, to provide for them at least a minimum decent and healthy environment, immunization and other preventive services, as well as medical and dental care when need arises is a public health responsibility of crucial importance for the economy of the State and needed in the humanitarian tradition of this great Nation.

(

The task becomes further complicated by the great distance the migrant worker and his dependents must travel to available health facilities, by his low income, lack of transportation, and indeed, often by his ignorance, lack of education and understanding of even the most basic principles of health protection.

Only through the efforts of comprehensive community planning involving the migrants, the farmers, community leaders, as well as voluntary and governmental health agencies can we hope to make inroads into the many and serious health problems affecting the migrant farm worker and his family. But planning alone is worthless when lack of funds stymies inception of the plan.

The Migrant Health Act of 1962 brought hope to the migrants, made communities look and realize their needs, and thus not only stimulated the planning process but provided the needed funds to assist Arizona communities in carrying out their plans. Through the incentive of the Migrant Health Act, Maricopa County and later Pima, Pinal and Yuma counties initiated migrant health projects that brought preventive and curative medical, nursing, nutrition and sanitation services to the migrants and their environment. In 1966, the Arizona State Department of Health started a statewide program of consultation and support to local efforts with emphasis on evaluating needs and progress, stimulating interest for health services in areas with migrant population where the need was not met, nd searching for more effective methods for the delivery of health services at the time and place where the health dollar spent would do the most good for the money.

Federal funds for migrant health projects in Arizona, supplemented by an estimated equal amount of local funds or services, provided for well-child and maternity services, family health clinics, family planning and immunization clinics, nutrition services, sanitary camp inspections for all farm labor camps, medical social work services, nursing visits, health education programs, contractual laboratory and X-ray diagnostic services, medical care, dental care, drugs and partial hospitalization cost for over ten thousand migrant farm workers and their dependents.

Yet, we have still a long way to go before reaching the goal of providing just the most needed services to all migrant farm workers in Arizona. In Cochise County, nursing service is the only available service for hundreds of migrant families. In Graham and Greenlee counties, nothing but very limited strict emergency services are available for an estimated seven to eight thousand migrants.

Even in Maricopa, Pima, Pinal, and Yuma counties, where successful migrant health projects have been established, our best estimate indicates that only fifty per cent of the migrant population are recipients of needed services. There is need for establishing basic health services in Cochise, Greenlee and Graham counties. There is need for expansion of migrant clinics in several areas in Yuma, Maricopa, Pinal and possibly Pima counties. There is need for expansion of dental services which in most areas are not available or limited to emergencies or to children under 9 or 10 years of age. There is need for payment of full cost for hospitalization in counties which simply cannot afford to carry their part of the cost. There is need for expansion of health education efforts in all migrant areas of the State in order to effectively improve the utilization of preventive services and thereby make real inroads in the health status of the migrant farm worker and his family, enabling him to take his rightful place as a wanted, needed, healthy and gainful individual in the community, which, after all, is dependent on his work ability for its own economy.

Through the extension and expansion of projects and Federal funds, as proposed in Senate Bill 2688 for a five-year period, it will be possible for this State hrough orderly and comprehensive planning to help integrate all service to the nigrants. It is needless to say that I endorse Senate Bill 2688. For further documentation of the need for passage of Senate Bill 2688 I am nclosing a copy of Arizona's Health, Vol. 1, No. 3, November, 1966, which upplements and illustrates the points that I have made in this letter. Sincerely,

GEORGE SPENDLOVE, M.D., M.P.H.,

Commissioner.

Casa GRANDE CLINIC,

Casa Grande, Ariz., January 11, 1968. Hon. HARRISON WILLIAMS, Chairman, Migrant Health Subcommittee, New Senate Office Building, Washington, D.C.

DEAR Sir: At this time of pending legislation, I felt that a short line about the Migrant Health Family Services Project in Pinal County, Arizona, night not only be timely but might explain some of our positions relative to the Program.

As you probably already know, Pinal County is an agricultural county in southern Arizona employing a rather incredible number of domestic migrant farm workers each year. Although the health problems of this particular group have improved considerably over the past several years, the conditions to a liewcomer (such as was in 1955) to this particular area, would make our meuical problems appear quite primitive. It is only through such Migrant Health Legis. lation as we now have that we are able to cope with the problem to any extent.

May I express my complete accord with the general feeling of the need, services, and the desirability of Migrant Health Legislation such as Senate Bill 2688. It will only be through legislation such as this that any inroad into migrant health problems may be made. Thanking you for the privilege of communicating with you, I remain, Sincerely yours,

R. F. SCHOEN, M.D.

SAN JOSE, Calif., December 20, 1967. Re extension of Migratory Health Act. Hon. HARRISON A. WILLIAMS, Jr., Chairman, Subcommittee on Migratory Labor, Committee on Labor and Public Welfare, U.S. Senate, Washington, D.C.

DEAR SENATOR WILLIAMS: In 1965 I established a family health service clinic for migrant seasonal farm workers in the South Santa Clara County area of California under the sponsorship of the County Medical Society. In 1966 and 1967 we received a Migrant Health Grant to keep the clinic in operation. The number of separate migrant individuals who come into this area during the crop season is estimated to be over 7,000 and 55% of these are youth. Ninety percent of these migrants are Mexican-Americans.

There is an abundance of statistics which I could present in order to indicate the significant health services provided by our clinic and the crucial need to continue to provide health care to migrants. However, I am sure you have sufhcient statistical data to prove your point for extension of the Migratory Health Act. Nor do I have the time to describe a variety of other services and activities associated with the clinic; suffice it to say that in addition to providing basic health care, we are involved in a number of social, educational welfare and recreational activities.

But there is something even more significant than all those things that results from the clinic of this sort, and I should like to relate a personal experience in an attempt to explain what I mean.

Shortly after we started the clinic in 1965, I had the opportunity one night to examine a 17-year old Mexican girl named Maria, who had arrived from Texas one week previously. She came to the clinic directly from a long day in the fields, with a complaint of headaches of three months' duration. Though dirty and tired, she was vivacious and attractive in her ragged jeans and workingman's shirt. She was highly intelligent and had a personality which charmed everyone it touched. Examination revealed signs of an advanced brain tumor. Through an interpreter I confidentially explained the seriousness of the problem to her father, who became extremely upset, particularly because his wife, Maria's mother, several years before had died from a brain tumor. Maria was sent to the County Hospital immediately, and I have never seen her since. The story might end here. However, several subsequent events have contributed toward making Maria a significant part of my life. I later learned that she was operated upon that same night for what proved to be a malignant tumor, and she was left with paralysis of one side of her body. Some inter-faith migrant volunteers heard about her and took it upon themselves to "adopt” her, as it were, with daily visits during the many months of difficult rehabilitation in the hospital; you can imagine how many loving relationships developed in the process. The father and the other children in the meantime had to move on to Salinas for work and survival. One night at the clinic, about two weeks after I had seen Maria, I discovered her father sitting among other patients waiting to see me. I was informed that he had made a special trip to personally, thank me. He merely grasped my hand, and with tears in his eyes said: “Maria lives ... gracias!” and then he quickly turned and left.

The next contact occurred six months later when I found an unexplained package of Salinas celery on the front porch of my home. Then I heard nothing until six months ago, when just by chance I heard a progress report on Maria from a local inter-faith migrant volunteer who had kept in close touch with the family from the very beginning. Maria had finally left the hospital and rejoined her family in Salinas and had managed to complete her high school studies in time for June graduation despite a severe handicap of one-sided weakness and speech difficulties. But the volunteer who gave me the report was much more excited about something else. She had just learned that Maria had accepted her invitation to spend the summer as her guest in San Jose!

How many lives in how many ways have been favourably effected by this one little migrant clinic ... we'll never know completely. But we do know in part!

There are many, many Marias migrating throughout our country, and I sincerely hope we can consider them as much with compassion as with computers. I urge that Senate Bill #2688 be passed. Respectfully yours,

STANLEY A. SKILLICORN, M.D.

COLORADO DEPARTMENT OF Public HEALTH,

Denver, Colo., December 19, 1967. Hon. HARRISON A. WILLIAMS, Chairman, Migrant Health Subcommittee, New Senate Office Building, Washington, D.C.

DEAR SIR: In reply to your invitation to submit a written statement in connection with the extension of the Migrant Health Act. We hope the following comments will be of assistance in assuring the passage of this much needed legislation.

Each year, approximately 20,000 migrant workers and their family dependents are engaged in the production of Colorado field crops. The classic problems of their mobility, poverty, and cultural isolation are compounded by the nature of crop production in our state. Due to the decentralization of farm housing, and the subsequent dispersion of the migrant population, delivery of health services is a difficult task.

season.

7. It was planned to employ an additional dental hygienist for six months to assist the full-time hygienist in screening and referral work during the migrant

8. Also included, was provision for a very modest in-patient hospital care program. It was estimated that an absolute minimum of 365 patients would require care at an average of 342 days per patient and at an average cost per patient of $215.00, with an estimated total cost of $78,475.00. In that Public Health Service (Migrant Health Branch) guidelines would have restricted us to only 53% of this, a total amount of $41,592.00 was applied for. Provision was also made for commercial transportation of patients to hospital facilities.

9. In order that the public health nursing program could be expanded in an orderly fashion, two critical areas were chosen to receive assistance. These were the Northeastern Colorado Health District and the Adams County area of the TriCounty Health Department of the metropolitan area. In both cases, provision was planned for the employment of a public health nurse during the migrant season in those respective areas.

10. A realistic increase in funding for dental services was requested which would have doubled the amount of patients who could have received care in 1968.

11. While no specific plans were incorporated in the application for the expansion of the Environmental Health Program, increases would have become necessary in view of the housing regulations recently promulgated by the U.S. Department of Labor. This would have required the employment of an additional sanitarian and three sanitarian aides. This, together with the other personnel increases would have required additional clerical assistance at the State level. The total amount required to fund this additional activity would be approximately $46,000.00 annually; this would be in addition to the $262,048.00 originally requested for the on-coming calendar year: a total of $308,048.00. Even this amount would not meet the need for a full-scale assault upon migrant health problems.

12. The current level of grant support, $157,581.00 to which we are to be held during 1968, does not realistically reflect migrant health needs in Colorado. It is barely sufficient to maintain program momentum. It will not enable us to make the necessary increases in program effort which are referenced above. Hospitalization, even at the minimal level planned, will remain unavailable, there can be no increase in meeting medical and dental needs, the public health nursing program will not progress at the necessary rate of speed, nor will any substantial improvement in the environmental health program be possible. Moreover, normal salary and other cost increases will make it necessary to omit or cut back some existing activities.

It is our hope that necessary legislation will be enacted which will enable our project, and others, to deliver health services at a realistic level to this segment of our population. Sincerely,

R. L. CLEERE, M.D., M.P.H.,

Director of Public Health.

TALBOTT FARMS, INC.,

Palisade, Colo., December 29, 1967. Hon. HARRISON WILLIAMS, Jr., Chairman, Subcommittee on Migratory Labor, U.S. Senate, Washington, D.C.

DEAR Sır: The Talbotts are probably the largest private employers of migrant labor in the state of Colorado. We have been in the fruit business here since 1942. We want to give our support to S-2688 which will continue and extend the funds for Migrant Health Services, such as we have been receiving under S-1130.

As growers, we have been greatly benefited by the health services given the agricultural migrants of our county. It has helped us recruit labor; it has stabilized our labor supply as it causes many more workers to return; and it has been a great convenience to us by making night clinics available. Fewer hours of work hare been lost and the general health and productivity of the workers have been higher. Your support of S-2688 will be greatly appreciated. Yours truly,

Mrs. H. A. TALBOTT,

Secretary-Treasurer, Talbott Farms, Inc. P.S.—We could send oral testimony in support of this bill by tape, if it would be helpful.